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Insurance Authorization Specialist
4 weeks ago
Department:
10010 Advocate Sleep Centers - Administration
Status:
Full time
Benefits Eligible:
Yes
Hours Per Week:
40
Schedule Details/Additional Information:
Remote position M-F 8am - 4:30pm
Major Responsibilities:
- The Authorization Specialist is responsible for verifying insurance benefits/eligibility for Commercial and Managed Care carriers for patients accessing hospital services
- 1)Verifies insurance benefits/eligibility for primary, secondary and tertiary insurance plans.
- 2)Utilizes Managed Care and Insurance web sites for determining eligibility and benefits.
- 3)Refers uninsured accounts to the Patient Financial Counselor.
- The Authorization Specialist is responsible for obtaining authorization and pre-certification for services from Commercial and Managed Care carriers for patients accessing hospital services
- 1)Accurately collects and analyzes insurance, financial, and clinical data from multiple sources, and obtains other information necessary for authorization, pre-certification and billing purposes.
- 2)Initiates telephone calls to the Primary Care Physician (PCP) or designee to obtain referral authorization and/or pre-certification for services.
- 3)Initiates electronic and/or telephone inquiries to insurance carriers for authorization and/or pre-certification for services
- 4)Contacts referring physician and appropriate clinical staff of unauthorized services.
- 5)Initiates communication with patients desiring services not authorized by their insurance carrier. Explains potential financial implications and responsibilities for services that are not authorized.
- 6)Initiates communication with patients desiring out-of-network hospital services. Explains potential financial implications and responsibilities for out-of-network services.
- 7)Refers patients to insurance carrier for explanation of benefits and details regarding their benefit plan.
- The Authorization Specialist is responsible for entering insurance benefits/eligibility, demographics, and pre-certification/authorization information in the patient accounting system
- 1)Ensures accuracy of benefit/eligibility information and carrier codes.
- 2)Processes demographic corrections as appropriate.
- 3)Completes data collection fields in the patient accounting system.
- 4)Electronically records information on a timely basis.
- 5)Accurately prepares required electronic and hard copy forms, documents, and reports necessary for registration and billing of services.
This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.
About Advocate Health
Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation's largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.
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